foot-shaped toe box

A maze of mythologies has surrounded the foot and footwear of infants and children for generations. As a result, by the time the average shoe-wearing child has reached the tender age of seven or eight, his or her feet clearly reveal a visible loss of anatomical and
functional normality. The medical practitioners are quick to attribute this to the wearing of “improper” or “ill-fitting” or out-grown shoes—not realizing that there is no other kind because all (99 percent) of juvenile foot-wear, regardless of price or brand, is
improper and ill-fitting.
It has been generally accepted by parents and medical practitioners alike that “proper footwear” was widely available for children, and if shoe-related foot disorders developed it was due to “ill-fitted” or “outgrown” shoes. There was little or no questioning the inherent design and construction faults of the shoes
themselves by medical practitioners or others. Children’s footwear was clothed in a holy shroud. Nobody saw the devils lurking inside.

Nothing Has Changed
Children’s footwear today is made, fitted and sold by the same naïve rules as a half-century and more ago. And the medical practitioners, continue to prescribe or recommend children’s footwear by the same seriously flawed rules of the past. The consequences? No shoe-wearing American or European adult owns a normal or unspoiled foot anatomically or functionally. By “normal” or “natural” is meant in comparison to the pristine feet among the estimated one billion people of the world that go through life unshod. Almost all of these physically deprived feet of adult Americans and Europeans begin in childhood with the wearing of faultily designed and constructed
footwear, starting in infancy. And all of this has occurred under the presumed “health guardianship” of the foot-related medical specialists.

The Myth of Support
The growing foot needs “support.” This popular myth not only persists, but also has led to an array of abuses by the doctors and shoe people alike. First, a question: Precisely where, how and why does a growing foot need support or reinforcement? One long-
common answer is that in shoe-wearing societies we walk on non-resilient floors and pavements, hence the growing foot needs to be protected by a buffer zone device such as a built-in arch support in the shoe or a steel shank or separate orthotic. This has no validity whatsoever. From infancy on, most of the hundreds of millions of shoeless people of the world habitually stand and walk…mostly on unyielding ground surfaces. Most shoeless children are raised in such environments…where the streets are either cobble-stoned or paved or with hard-packed turf. Those uncovered, “unsupported” feet grow with strong, normal arches.

Heels and Toes
For centuries, right to the present day, one of the most foot-negative features on juvenile shoes has been the use of raised heels. Relative to body height, a one inch heel worn
by a child of seven is the equivalent of a two-inch heel worn by an adult. So almost all children above age seven are wearing “high” heels the equivalent of two inches in
height—and neither the shoe industry nor the doctors has any idea of this absurdity occurring before their eyes. A raised heel of any height under the foot of a growing child
automatically destabilizes the foot and the whole postural column. Such a foot is thus predestined to grow with anatomical and functional faults—much the same as a young tree planted with its trunk on a slant. The heels usually start with “first walker” shoes (10th to 12th month) and have a 3/8th-inch lift called a “spring heel” which is supposed to add forward “spring” to the step and aid in the walking. But the spring heel actually unbalances the body column and disrupts the natural balance and forward movement of the infant.
An elevated heel of any height on a child’s shoe shortens the growing Achilles tendon—the beginning of a permanent tendon shortening that begins in infancy and continues through a lifetime for all shoe-wearing people. Further, the elevated heel shortens the plantar fascia (arch) by contracting the foot and shortening the distance between
heel and ball. An elevated heel on the footwear of small, growing children is both
absurd and cruel. Among young children there is no demand or clamor for heeled shoes. The heels are imposed on the children by the shoe manufacturers, taken for granted by the parents, and accepted without question by doctors.
No footwear for children (or adults*)…should be made with an elevated heel. Exceptions might be made for girls shoes beginning about age ten if desired for peer fashion reasons. This allowance would be made on the grounds of right of choice—though not the rightness of choice.

Anti-Foot Lasts / Loss of Toe Function
Almost all Lasts for children’s footwear, including sneakers, are “crooked” in contrast to the straight-axis alignment of the foot, heel-to-toes. This has long been one of the chief causes of anatomical and functional foot deformity that begins in childhood and continues throughout all the adult years. Why this obstinate continuation of crooked-last shoes that are so obviously anti-foot health? Tradition again. Shoes have been made on crooked lasts for centuries, so the manufacturers, along with the shoe retailers, continue to remain blissfully ignorant of this visible conflict between foot and shoe and hence resist or refuse change.
In any shoe-wearing society, by age eight or nine, the toes of most children have lost up to 50 percent of their natural prehensile and functional capacity. They are no longer strong, finger-like, ground-grasping organs but weak appenditures at the end of the foot. By early dulthood the toes will reveal visible symptoms such as tapered shape, bunions, crooked or hammer toes, nail disorders, etc.

Infants Shoes
In all shoe-wearing societies…the anatomical deformity and functional delinquency of the foot begins at about the sixth or seventh month when the infant, still in its crib, is fitted to pre-walker shoes, a laced bootie. Despite the fast-growing foot, the crib shoes
are worn until about the 11th or 12 th month when the infant begins to walk and is fitted to its first shoes—again a laced bootie, but a firmer sole. It’s as though the parents, shoe people and doctors can’t wait to begin the primitive process of foot-wrapping, little different than the old Chinese footbinding customs that began when the girl was about
age six.
The infant, displaying more common sense than the parents, shoe people or doctors, struggles to pull off the alien wrappings on its feet. These are primitive conditions and attitudes when the foot is at its most vulnerable stage. But under prevailing practices, the infant foot is usually pre-doomed to a high-risk life ahead.
Surveys reveal that, for parents, the single most memorable event for them during an infant’s life span is its first steps. With those first steps the infant is now ready for prime time. So onto its feet go its “first-stepper” shoes. And suddenly, the infant, having successfully launched its walking career barefoot, finds itself struggling to maintain balance and locomote with stiff, constrictive, alien objects on its feet. It labors to take “normal” steps with shoes on—a physical and biomechanical impossibility…First, the shoe’s soles…are one-fourth to three-eighths of an inch thick. They automatically prevent 80 to 90 percent of the child’s normal flex angle. The steps are pancake-like, seriously hampering the gait mechanics. The thick soles commonly used on infant shoes and sneakers are an absurdity. Infants never wear out their shoe soles.

What these experiences clearly demonstrate is that if the foot is permitted to reach adulthood unspoiled by shoes, the foot will be a quite different object anatomically and functionally than the foot shod from infancy into adulthood. Hence the obvious conclusion: In any shoe-wearing society there is no such thing as a natural or “normal” foot anatomically and functionally.
The shoe-wearing foot has been anatomically conditioned from infancy to acquire the faulty shape to adapt to the faulty shoe. This contradicts the rule: you can’t fit a square peg into a round hole. But you can. You simply shave the corners or edges of the square peg until they are rounded, and the once-square peg fits neatly into the round hole. This is precisely what happens to all shoe-wearing feet. So we arrive at the deceptive illusion that all once-square-pegged feet are “normal” because they fit into the round hole.

Where To From Here?
An excerpt from a U.S. Department’s public statement: “Our studies show that the most criticized factor contributing to the controversy about orthopedic footwear is the lack of knowledge or training of most medical practitioners…The attending physician or medical
specialist is not normally schooled about footwear.” It has long been assumed that children’s footwear is generally healthful because it allows for normal foot development by avoiding the “sins” of adult footwear (high heels, pointed toes, vanity, too-
small sizes, fad fashions, etc.). This is seriously naïve. Over the past 50-100 years virtually every branch or specialty of medicine has made substantial contributions to disease prevention and health improvements in its field. Only podiatry has failed on this score. While podiatry has made appreciable advances in the treatment of foot disorders, it has added almost nothing to the science of prevention.

Here are two proposed steps for launching the initiative:

1) A mass professional policy urging parents to keep their infants shoeless through the first three years. This would give the foot a healthy head start.

2) Urge all parents to adopt the shoeless-at-home-rule for their children through age 12, and suggesting that the parents apply the same rule or habit to themselves.

Once introduced, the shoeless-at-home habit is eagerly adopted by juveniles because of the “freedom” feeling. Having acquired the shoeless habit up through age 12, most children will continue with it well into the late teens and often beyond. The obvious consequence would be a marked improvement in child foot health and continuing
into the adult range over the subsequent years. The APMA should assume leadership here by taking an official stance and using the muscle of its public relations sector. Podiatrists would supplement this by similar advice and guidance to office patients. So, while teens would likely continue to go shoeless at home, they would adopt and wear the peer fashion footwear outside. But by then healthy child foot development will have gotten off to a vigorous head start—something that rarely occurs in any shoe-wearing society.
Podiatry must now begin exchanging the old platitudes concerning the foot/shoe linkage in child foot development for the new realities. It must confront the simple premise that children’s feet fare better without rather than with shoes.

Dr. Rossi, a shoe industry consultant, has written eight books and over 400 articles, including extensive additions on leather and footwear in Encyclopaedia Brittanica.

Healthy Running Philosophy: How to be a Better Runner & Run Injury Free

One of the most common questions runners ask me is how they can improve and at the same time stay healthy. Although there is no proven way to do this, I feel that I’ve learned a lot through the years that can be passed on. I spent my years in college studying running injuries & running technique, and I also worked in a running store for nearly 2 decades where learning to help people not hurt was the name of the game. Through my studies and hands on experience, I’ve come to believe there are four major causes of running injuries:

Repetitive Stress & Muscle Imbalances
World renowned Exercise Scientist & 1984 Olympic Trials Marathon Champion Pete Pfitzinger wrote “Most running injuries occur because of the repetitive nature of the running stride…You can address…by correcting muscle imbalances…and by adjusting your running surface…”(1) Our bodies were not created to run repetitively on a uniform surface such as a road, track, or treadmill. Therefore, it is imperative that runners search out and run on variable, uneven surfaces such as trails, cobblestones, and grass as much as possible. This allows more intrinsic and stabilizing muscles to get involved, thereby balancing the muscle structure. A soft surface like a track will not reduce injury. In fact, track running actually encourages more injury because it is so extremely consistent. The more different each step is and the more the whole body gets involved, the more effective the surface is at preventing injury. My studies in college showed that trail runners were far less injured than road runners, but that most runners could reduce injury by running one-third of their mileage on variable terrain. The book Anatomy for Runners by Jay Dicharry is the comprehensive source on why muscle balance matters and how to avoid injury.

Poor Running Technique
Since most runners have never been trained on HOW to run efficiently with low impact, most of them over-stride and run with inefficient, high impact running technique. Unfortunately, most shoes literally teach bad form as well, because most running shoes have elevated heels that are twice as heavy and twice as thick as the forefoot of the shoe. In any other sport, there is focus on performing the tasks of the sport correctly to reduce injury and improve performance—running should be no different. Become a student of good running form to learn how to protect your body. I highly recommend filming yourself as most people don’t run the way they think they run! Additionally, getting a pair of Zero Drop shoes—shoes without an elevated heel—will make it much easier to run with good technique. Any heel elevation, even 4mm, will cause a weight and height imbalance that will encourage an early, unnatural foot-strike. Although there is no ideal running form, there are a few things that nearly all elite runners and non-injured runners have in common:

1) Proud, Forward Momentum Posture: Hips & Chest are pushed forward without bending at the waist.
2) Compact Arms: Elbows shouldn’t swing forward past the hips unless sprinting—this will keep the body in proper position and prevent over-striding.
3) Soft Landing Under a Bent Knee: Don’t think about foot-strike, as it will take care of itself if the other points are done correctly. Most people will naturally land somewhere between a slight heel strike and the middle of the foot. Excessive heel striking or forefoot/toe striking is discouraged.
4) High Cadence: Nearly all elites have been observed to have around 180+ steps per minute. For most people, ultimately shooting for at least 170 steps per minute will drastically improve form, improve foot-strike, and reduce impact.
See www.AltraRunBetter.com for more detail. I also recommend reading Programmed to Run by Dr. Tom Miller.

Poor Foot Strength & Function
To improve performance and avoid injury from the ground up, both the foot and the core of the body need to be strong and in their natural position. The foot is the foundation of the body and it is therefore critical that the foot be strong & be allowed to function naturally—yet most Americans have weak feet that are inhibited by shoes that move their feet out of natural position and function by raising their heels and crowding their toes with pointy toe-boxes.
Keep your body in its natural position whenever possible. Your running shoes are important, but what you wear the rest of the day is equally important. If your shoes aren’t the same shape as your spread out foot in a sock, get new shoes. Shoes that will put your feet in their most natural, powerful position will not include tapered toe-boxes, elevated heels, or excessive “arch support”.

Tapered toe-boxes don’t allow the foot & toes to naturally absorb impact, stabilize the body, and push off the ground the way they are meant to. They also contribute to bunions, neuromas, Plantar Fasciosis, and other foot maladies.
Elevated heels shorten the calves and Achilles tendon and make the body column compensate, causing extra pressure on the lower back, hips, & knees. Therefore shoes should be flat, flexible, and shaped like healthy feet. Wearing footwear like this will allow your feet to function properly and become strong and dynamic. The stress on the feet from hard, consistent, man-mad surfaces can be reduced by having some cushioning in the shoe.
Excessive “arch support” and/or orthotics weaken the feet and create a vicious addiction cycle until the feet are strengthened and learn how to work without them again. Those addicted to supposed “arch support” need to strengthen their feet and slowly phase the orthotics or arch supports out over a period of a few months as their feet get stronger and become the support.

Additionally, most Americans sit all day at work and have weak core muscles. If you sit at work, consider using an exercise ball as a chair some of the time. Take walks at least every hour if possible. It is also critical to strengthen core muscles through Strength Training, Yoga, Pilates, Climbing, or other Cross Training Activities.

Over-training
Combating over-training is one of the hardest things for a runner to do. For most of us, it is in our nature to push it. We get excited about a race or how our training is going and then we push it too hard. Unfortunately, the best solution to this one seems to be to stop being a runner! In all seriousness though, just remember that training smarter is better than training harder. It is proven that you will get improve more from running a Lactate Threshold workout at 15k to Half Marathon pace and NOT by going faster. It is also proven that your v02Max workouts will give your body benefit at your 3k to 5k pace and you will get more benefit at that pace than by running harder. I recommend reading “Road Racing for Serious Runners” to better understand how to get faster by training smarter and not harder.
It is almost inevitable that a runner will get sick, experience a life event that disrupts running, or get injured in some form during training—often this will be non-running related. For this reason, I highly recommend planning a couple weeks of down time in to each training season. If and when you have to use this time, it doesn’t affect you as negatively because you’ve planned on it. If you don’t have to use it, you’re just that much further ahead.

There are probably a thousand other items that could be added in, but these are some of the big ones! At the end of the day, most runners can avoid injury by avoiding over-training, becoming a student of their running form, running on natural, variable surfaces, and by putting their body in its natural, most powerful state.

During the nearly twenty years I spent working and managing a running store, I often heard the same question quite often: “What shoes should I get if I’ve never really had running shoes before?” It was always a tough question, because each individual is so different and has different needs when it comes to how much cushion or support they could benefit from. With that said—with any sport, there is always a universal need to learn HOW to do the sport properly and have the right equipment that encourages proper technique. In fact, in some sports, beginners are often given pieces of equipment that are training tools that over-emphasize proper form or expedite the learning process.

Unfortunately, the running world hasn’t seemed to have caught on to this yet. In fact, running is probably the only sport we spend virtually no time teaching new-comers how to properly do the sport and just tell them to “go run”. No wonder the injury rate is so high! This is equivalent to taking a kid and throwing him in the pool and just saying “go swim”, or giving a kid a basketball and saying “go shoot!” Sure, you’ll get better over time, but it will be slow and painful, you’ll likely get injured over time, and you’ll most likely have to unlearn some bad habits as you progress.

Additionally, running is probably the only sport where our equipment typically works against us and encourages less than ideal technique. Indeed, most running shoes encourage beginning runners—and all runners—to run WRONG! The vast majority of running shoes contain cushioning that is twice as heavy and twice as thick in the heel as it is in the front of the shoe. This additional weight and height in the heel of the shoe causes a runner to land more out in front of their body, and more on their heels. Simply put, most traditional running shoes encourage a runner to run with higher impact, inefficient form than they otherwise would.

If you are having a hard time believing this, simply film yourself running for 5 minutes in traditional running shoes, and then film yourself for 5 minutes running barefoot or in a shoe that is very thin or perfectly flat. Watch the last minute of each video. The changes in landing (foot strike), knee angle, overall posture, and stride rate (cadence) are incredible! With that said, I’m not advocating barefoot for beginners—unless they are VERY patient people and want to start barefoot—for a variety of reasons. More on this later.

Running is also likely the only sport where our main piece of equipment puts our body in a less than ideal position for balance, stability, and power. The ability of the foot to naturally spread out on landing, stabilize the body further by engaging the big toe, and powerfully push off from this position is a critical piece of being able to run efficiently and injury free. Simply put, the foot should be able to spread out upon landing and therefore 1) absorb impact, 2) naturally stabilize, and 3) push off the ground efficiently. As the foot hits the ground and spreads out into its widest position, it is naturally more powerful and more stable. Think of the wide, low stance of a sports car or trying to do push-ups with your fingers together versus spread apart.

Unfortunately, although feet are naturally widest at the toes, most running shoes feature tapered toe boxes that are shaped more like torpedoes than they are like healthy human feet. X-ray images show that tapered toe boxes cause significantly more bone stress in the feet, which is a precursor to stress fractures. This tapered shape inhibits the body’s ability to naturally spread out the foot to absorb impact, stabilize, and push off the ground powerfully. To drive the point home, the majority of people buy shoes too narrow for their feet. In fact, the width of the average female shoe sold is nearly 2 sizes narrower than the average female foot. No wonder 73% of Americans report foot pain as compared to only a 3% incidence in non-shoe wearing populations! Take a look at your foot in a non-constricting sock and compare that shape to the shape of your shoe and you’ll understand what I’m talking about. If you’ve been wearing shoes that are too narrow for many years, your feet may be starting to look more like the shoes you wear than actual feet, which is a precursor to many foot problems, and only gets worse with age. If this is you, I recommend something called Correct Toes to help get your feet back to a naturally functioning & healthy shape.

Now ultimately, a beginning runner can also benefit from some degree of cushioning and support to protect the feet from man-made surfaces and allow them to progress faster than they would otherwise.

So ultimately, in my opinion, and the opinion of the American College of Sports Medicine, the ideal running shoe for a beginning runner would not contain the heavy, elevated heel that teaches poor, high impact technique. The ideal running shoe for a newer runner would also not feature a traditional tapered toe box which ultimately inhibits impact absorption and is responsible for so many common foot maladies. A great running shoe for a beginner would also have just enough cushioning to allow them to be comfortable and allow them to progress and add mileage on a variety of surfaces. An important consideration should be made that some newer runners may have weak feet, and could benefit from using a very soft, lightweight arch support until their feet become strong enough to go without it.

For these reasons, I believe newer runners are best off in a shoe that is cushioned but Zero Drop, and shaped like a healthy human foot. These things will allow the foot to function properly and the body to run with efficient, low impact running technique. In short, a cushioned, Zero Drop, Foot-shaped shoe like Altra will help a beginning runner learn good habits from the start and possibly reduce many injuries instead of the status quo. As with all things, I recommend trying things out first to make sure it works for you, as each of us is an individual with unique needs. Happy Running!

-K. Golden Harper

Golden graduated with a degree in Exercise Science and did his collegiate studies on running technique & running injuries. He grew up working in his family’s running store and holds a world-best for a 12-year old in the marathon at 2:45:34.